Provider Demographics
NPI:1235200619
Name:OSTBY, KRADAN (OT)
Entity Type:Individual
Prefix:
First Name:KRADAN
Middle Name:
Last Name:OSTBY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1896 MURDOCK RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6758
Mailing Address - Country:US
Mailing Address - Phone:770-565-9194
Mailing Address - Fax:770-565-9194
Practice Address - Street 1:4310 JOHNS CREEK PKWY
Practice Address - Street 2:100
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6091
Practice Address - Country:US
Practice Address - Phone:770-814-2900
Practice Address - Fax:770-814-7790
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT001374225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist